Ann R Coll Surg Engl. 2009 Feb 13.

Visual and computer software-aided estimates of Dupuytren's contractures: correlation with clinical goniometric measurements.

Smith R, Dias J, Ullah A, Bhowal B.

INTRODUCTION Corrective surgery for Dupuytren's disease represents a significant proportion of a hand surgeon's workload.The decision to go ahead with surgery and the success of surgery requires measuring the degree of contracture of the diseasedfinger(s). This is performed in clinic with a goniometer, pre- and postoperatively. Monitoring the recurrence of the contracturecan inform on surgical outcome, research and audit.PATIENTS AND METHODS We compared visual and computer software-aided estimation of Dupuytren's contractures to clinicalgoniometric measurements in 60 patients with Dupuytren's disease. Patients' hands were digitally photographed. There were76 contracted finger joints - 70 proximal interphalangeal joints and six distal interphalangeal joints. The degrees of contractureof these images were visually assessed by six orthopaedic staff of differing seniority and re-assessed with computer software.RESULTS Across assessors, the Pearson correlation between the goniometric measurements and the visual estimations was0.83 and this significantly improved to 0..8 with computer software. Reliability with intra-class correlations achieved 0.78and 0.92 for the visual and computer-aided estimations, respectively, and with test-retest analysis, 0.92 for visual estimationand 0.95 for computer-aided measurements.CONCLUSIONS Visual estimations of Dupuytren's contractures correlate well with actual clinical goniometric measurements andimprove further if measured with computer software. Digital images permit monitoring of contracture after surgery and mayfacilitate research into disease progression and auditing of surgical technique.

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